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Nephrology Fellowship Reviewer > Hypertension > Flashcards

Hypertension Flashcards

1
Q

acceptable increase in creatinine within first 2 months of aceinhibitor therapy

A

30%

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2
Q

First line therapy: Acei
6

A 
Htn with hf and systolic dysfunction 
type 1 dm and proteinuria 
mi or cad 
new af 
left ventricular dysfunction
hd
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3
Q

selectively antagonize Ang II at the AT1 receptor

A

ARB

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4
Q

B receptor predominantly in heart adipose and brain tissue

A

B1

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5
Q

B receptor in lung liver smooth muscle and skeletal muscle

A

B2

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6
Q

B1 selective

A

Atenolol, Metoprolol, Bisoprolol, Acebutolol

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7
Q

Nonselective + A blockade or other mechanism

A

Labetalol Carvedilol Nebivolol

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8
Q

coexisting heart failure and htn

Anti htn class

A

B blocker

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9
Q

inhibit entry of calcium or its mobilization from intracellular stores, lower peripheral resistance

A

Calcium channel blockers

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10
Q

Most potent vasodilator among ccb

A

dihydropyridines - amlodipine, nifedipine

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11
Q

augment atrial natriuretic peptide release

A

ccb

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12
Q

important tx option for renal transplant recipients - reduces initial graft nonfunction by attenuating ischemic and reperfusion injury, preserves long term renal function by protecting against cyclosporine nephrotoxicity

A

CCBs

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13
Q

cause of edema in dihydropyridines

A

uncompensated precapillary vasodilation

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14
Q

crosses the blood brain barrier and have a direct agonist effect in a2 adrenergic receptors in the midbrain and brainstem

A

central adrenergic agonist

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15
Q

most common adverse effect of alpha agonist

A

dry mouth

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16
Q

decrease peripheral vascular resistance, act directly on vascular smooth muscle

A

direct acting vasodilators

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17
Q

direct vasodilator reserved for severe or intractable hypertension

A

minoxidil

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18
Q

common adverse effect of minoxidil

A

hypertrichosis

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19
Q

associated with development of sle (direct vasodilator)

A

hydralazine

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20
Q

derivative of spironolactone that is approx 24x less potent in blocking mr than spironolactone

A

eplerenone

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21
Q

Bp target < 60

A

< 140/90

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22
Q

Bp target > 60 yo

A

< 150/90

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23
Q

Ideal therapy for older patients

A

vasodilators - ace/arb + hctz, ccb

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24
Q

optimal therapy in pregnant

A

a-methyldopa, hydralazine or bblocker

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25
Q

angina tx

A

Bblocker, nitrates, ccb

reduce hr and induce vasodilation

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26
Q

Lvh htn tx

A

hctz acei ccb arb
avoid vasodilators
reduce sbp

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27
Q

systolic dysfunction htn tx pharma consideration

A

reduce afterload and preload

acei, arb, hctz, bblocker, aldactone

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28
Q

diastolic dysfunction
Goal
Meds

A

improve myocardial compliance
bb, ccb, acei arb
avoid loop diuretics

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29
Q

MI

A

reduce heart rate, bb, acei

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30
Q

inability to reach desired bp goal despite the use of 3 optimally dosed drugs, one of which is a diuretic or need for four or more medications yo reach desired goal

A

Resistant htn

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31
Q

most common cause of resistant htn

A

non adherence

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32
Q

most potent parenteral vasodilator - dilates arteriolar resistance and venous capacitance vessels

A

sodium nitroprusside

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33
Q

degree of pressure gradient between aorta and poststenotic renal artery before measurable release of renin develops

A

10-20mmhg

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34
Q

critical lesions require how much of luminal obstruction before hemodynamic effects are detected

A

70-80%

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35
Q

Effects of angiotensin II

A 
vasoconstriction 
renal Na retention 
aldosterone secretion 
Vascular effects 
Sns 
myocardial effects
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36
Q

affects the intima or fibrous layers of the vessel wall, F, smoking, classically away from renal artery, string of bead appearance

A

fibromuscular disease, medial fibroplasia

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37
Q

most common cause of renovascular disease, at origin of artery

A

atherosclerosis

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38
Q

appear in the midportion of the vessel, strong predilection for the R renal artery

A

medial fibroplasia

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39
Q

syndromes associated with renovascular hypertension
7

A
  1. Early or late onset htn
  2. acceleration of treated essential htn
  3. Deterioration of renal function in treater essential htn
  4. Acute renal failure during treatment of hypertension
  5. Flash pulmonary edema
  6. Progressive renal failure
  7. Refractory congestive cardiac failure
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40
Q

lateralization is defined as a ratio of more than ___ between the renin activity of the stenotic kidney and the nonstenotic kidney

A

1.5

41
Q

used to monitor after renal revascularizarion to monitor restenosis and target vessel patency

A

Doppler studies

42
Q

gold standard for definition of vascular anatomy and stenotic lesions in kidney

A

Intra arterial angiography

43
Q

resistive index that reflects intrinsic parenchymal and small vessel disease in the kidney that does not improve after revascularizarion

A

> 80

44
Q

Most frequently reported complication after ptra and stenting

A

Minor - groin hematoma and puncture site trauma

45
Q

Creatinine and size of kidneys which will unlikely benefit from surgical or endovascilar procedures

A

Crea > 3 cm, Small kidneys < 8 cm

46
Q

Indications for revascularizarion
5

A 
circulatory congestion
deteriorating kidney function 
bilateral high grade ras
solitary functioning kidney
uncontrolled hypertension
47
Q

Screening in primary hyperaldosteronism

A

Plasma aldosterone concentration to renin activity: ARR of 30

48
Q

False positives Arr
4

A

K and Na loading,
bb,
nsaid,
ckd

49
Q

False negative primary hyperaldosteronism
5

A

HypoK,
diuretics,
acei,
arb,
ccb

50
Q

confirmatory tests for Pa
4

A

Saline loading
oral Na loading
fludricortisone
Captopril challenge

51
Q

+ saline loading test

A

plasma aldosterone > 10 ng/ml (2L in 4h)

52
Q

+ oral sodium loading test

A

urinary aldosterone > 12-14 mcg/day (6g/day for 3-5 days)

53
Q

+ fludrocortisone suppression test after 0.1 mg of fludrocortisone every 6 hrs for 4 days

A

+ if upright plasma aldo > 6 ng/dL and renin/cortisol low

54
Q

+ captopril challenge test after 20-25 mg

A

+ plasma aldosterone elevated and unchanged after 1 amd 2h

55
Q

initial study in subtype testing of pa

A

adrenal ct

56
Q

small hypodense nodule (2 cm in diameter)

A

Aldosterone producing adenoma

57
Q

normal adrenals or nodular changes

A

Idiopathic hyperaldosteronism

58
Q

> 4 cm, heterogenous, indistinct margins, hemorrhage and necrosis

A

Aldosterone producing adrenal ca

59
Q

medical management for GRA

A

low dose dexa/pred

60
Q

11B-hydroxysteroid dehydrogenase deficiency

A

licorice

61
Q

htn hypoK inappropriate kaliuresis with low aldosterone and renin

A

liddle syndrome

62
Q

headache, sweating, hypertension in paroxysms

A

Pheochromocytoma

63
Q

tx of pheochromocytoma

A

alpha blocker - phentolaminr or phenoxybenzamine

64
Q

screening for acromegaly

A

Insulin like growth factors

65
Q

tx for aortic dissection
2

A

bblocker plus nitroprusside

120 mmhg in 20 mins

66
Q

phenomenon where a mild increase in blood pressure results in a concomitant increase in Na excretion

A

Pressure natriuresis

67
Q

factor produced by adipocytes found to impair nitric oxide synthesis and enhances endothelin 1 production favoring the devt ko htn in obesity

A

resistin

68
Q

when decreased causes insulin resistance, decreased induction of enos, increased sympathetic activity

A

adiponectin

69
Q

When increased heightens sns

A

leptin

70
Q

causes Na retention causing increased bp

A

angiotensinogen

71
Q

isolated office htn, high bp in the office and normal bp in the out of office environment

A

White coat htn

72
Q

normal bp in the office, increased outside

A

masked htn

73
Q

difficult to control bp with 3 optimally dose drugs one of which is a diuretic, need for 4 or more medications

A

resistant htn

74
Q

orthostatic hypotension is defined as a drop of more than how many mmhg in BP after 3 mins of standing

A

20/10

75
Q

labile htn and hypotensive symptoms

A

home bp monitoring

76
Q

gold standard when patients have home bp values that are borderline

A

abpm

77
Q

monitor orthosatic htn

A

home bp

78
Q

supine htn and average levels of bp

A

abpm

79
Q

autosomal dominant disorder with htn, met alk, low aldo and low renin, increased bp with aldactone intake

A

hypertension brachydactyly syndrome

80
Q

hypokalemia, met acid with normal renal fxn, htn

A

gordon syndrome

81
Q

hypok, met alk, low plasma aldosterone and renin, enac mutation

A

liddle syndrome

82
Q

hypok met alk low plasma and aldosterone, mutation in 11B hydroxysteroid dehydrogenase type 2

A

Apparent mineralocorticoid excess

83
Q

Mutation in MR, hypok and met alk, low aldosterone and renin, increased bp due to pregnancy or aldactone intake

A

Geller syndrome

84
Q

mutationnof hypertension brachydactily syndrome

A

phosphodiasterasr E3a

85
Q

short fingers, stature; brainstem compression from

vascular tortuosity in the posterior fossa

A

htn brachydactyly syndrome

86
Q

patients who lack normal BP dip of 20% during sleep

sleep bp that falls by less than 10% compared with awake levels

A

nondippers

87
Q

cut off of high renin

A

6.5 ng/mL/hr

88
Q

medication of choice high levels of renin

A

acei, arbs, renin inhibitors, bblockers

89
Q

Low levels of renin tx of choice

A

diuretics, aldosterone antagonists, ccbs or a blockers

90
Q

when to work up for secondary htn
6

A

htn younger than 30 with no family hx of htn
> 55 yo with new onset htn,
worsening of bp control,
recurrent flash pulmo edema,
abdominal bruit,
inc of more than 30% after raas blocker

91
Q

treatment of primary hyperaldosteronism

A

verapamil, hydralazine, peripheral a adrenoreceptor antagonists

92
Q

cut off size to consider adrenal adenocarcinoma

A

> 4 cm

93
Q

diffuse hyperplasia of aldosterone producing cells within adrenal cortex

A

idiopathic hyperaldosteronism

94
Q

enlarged limbs of one or both adrenal glands > 10 mm thick

A

Unilateral adrenal hyperplasia

95
Q

Management for acute aortic dissection

A

sbp < 120 within 20 mins

Bblocker and vasodilator

96
Q

bp target for htn with hemorrhage

A

10-15% reduction over 1-2 hrs

97
Q

bp target for major hematuria or kidney injury

A

0-25% reduction in map over 1-12 h

98
Q

Bp target for hypertensive enceph

A

25% over 2-3 h

99
Q

bp target for acute head injury

A

0-35% reduction over 2-3h with nitroprusside

Nephrology Fellowship Reviewer (29 decks)

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